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Strategizes for optimal business practices and efficiencies with an emphasis on producing revenue for the corporation. Position plans, provides resources and directs activities in network development, provider contracting/negotiation and provider service functions.
Sets goals for their area and works closely with Managers/Representatives to drive performance and to ensure provider satisfaction metrics are met or exceeded.
Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results.
Plans, conducts and directs provider contracting/negotiations and provider servicing.
Develops practices to assist risk partners in managing financial risk.
Performs data analysis and develops specific actions to manage medical cost trends.
Plans, provides resources and directs activities, network development, provider contracting/negotiation and provider service functions.
Develops provider contracting and service strategies and ensures maximum efficiencies in the utilization of human and financial resources.
Strategizes for membership growth, retention, and to affect sophisticated or complex provider relationships.
Maintains compliance for State and CMS audits.
Special projects as assigned or directed.
This position is contingent upon the bid award in the state of North Carolina to WellCare Health Plans, Inc.
Required A Bachelor's Degree in a related field or equivalent work experience directly related to the level and duties of the job
Required 7 years of experience in provider relations or similar background
Required 4 years of experience in management
Intermediate Demonstrated leadership skills
Intermediate Ability to lead/manage others
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to influence internal and external constituents
Advanced Demonstrated analytical skills
Advanced Other Facilitative skills
Intermediate Other Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace
Intermediate Other Ability to convert related activities into a comprehensive work plan
Advanced Other Financial skills
Advanced Other Knowledge of CMS and state regulations
Licenses and Certifications: A license in one of the following is required: